Giannone Gaia, Castaldo Daniele, Tuninetti Valentina, Scotto Giulia, Turinetto Margherita, Valsecchi Anna Amela, Bartoletti Michele, Mammoliti Serafina, Artioli Grazia, Mangili Giorgia, Salutari Vanda, Lorusso Domenica, Cormio Gennaro, Zamagni Claudio, Savarese Antonella, Di Maio Massimo, Ronzino Graziana, Pisano Carmela, Pignata Sandro, Valabrega Giorgio
Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia (FPO) - IRCCS, Candiolo, Italy.
Department of Oncology, University of Turin, Turin, Italy.
Front Oncol. 2022 May 27;12:880008. doi: 10.3389/fonc.2022.880008. eCollection 2022.
Endometrial cancer (EC) therapeutic and diagnostic approaches have been changed by the development of a new prognostic molecular classification, the introduction of dostarlimab in microsatellite instability (MSI) high pre-treated advanced EC patients with further expected innovation deriving from lenvatinib plus pembrolizumab regardless MSI status. How this is and will be translated and embedded in the clinical setting in Italy is not known; this is why we developed Multicentre Italian Trials in Ovarian cancer and gynaecologic malignancies (MITO) survey on the current practice and expected future changes in EC.
We designed a self-administered, multiple-choice online questionnaire available only for MITO members for one month, starting in April 2021.
75.6% of the respondents were oncologists with a specific focus on gynaecologic malignancies and 73.3% of the respondents declared the availability of clinical trials in second line treatment for advanced EC. The therapeutic algorithm in second line was heterogeneous, being the most frequent choice administering anthracyclines followed by endocrine therapy or enrolling in clinical trials. While more than half of the clinicians declared that they performed the molecular classification, only six/45 respondents (13.3%) ran all the tests needed for it. On the other hand, 80% of them declared regular assessment of MSI status with IHC as recommended. The therapeutic approach in MSI high advanced EC patients has changed since dostarlimab approval. Indeed the most frequent choice in second line has been chemotherapy (53.3%) before its availability, while dostarlimab has been preferred in more than three-fourths of the cases (75.6%) after its approval. As for MSS patients, 77.8% of clinicians would choose lenvatinib plus pembrolizumab for them in second line once approved.
Despite the selected sample of respondents from Italian MITO centres showing good knowledge of diagnostic and therapeutic innovations in EC, these are not fully implemented in everyday clinics, except for MSI status assessment.
一种新的预后分子分类的发展改变了子宫内膜癌（EC）的治疗和诊断方法，多斯塔利单抗被引入用于微卫星不稳定（MSI）高的预处理晚期EC患者，并且无论MSI状态如何，乐伐替尼联合帕博利珠单抗有望带来进一步创新。目前尚不清楚这在意大利将如何以及是否会转化并融入临床实践；这就是我们开展意大利卵巢癌和妇科恶性肿瘤多中心试验（MITO）调查的原因，以了解EC当前的实践情况以及预期的未来变化。
我们设计了一份自填式多项选择在线问卷，从2021年4月开始，仅对MITO成员开放一个月。
75.6%的受访者是专注于妇科恶性肿瘤的肿瘤学家，73.3%的受访者表示有晚期EC二线治疗的临床试验。二线治疗的算法各不相同，最常见的选择是给予蒽环类药物，其次是内分泌治疗或参加临床试验。虽然超过一半的临床医生表示他们进行了分子分类，但只有6/45的受访者（13.3%）进行了所需的所有检测。另一方面，80%的受访者表示按照建议通过免疫组化定期评估MSI状态。自多斯塔利单抗获批以来，MSI高的晚期EC患者的治疗方法发生了变化。确实，在多斯塔利单抗可用之前，二线治疗中最常见的选择是化疗（53.3%），而在其获批后，超过四分之三的病例（75.6%）首选多斯塔利单抗。对于微卫星稳定（MSS）患者，一旦获批，77.8%的临床医生会在二线治疗中为他们选择乐伐替尼联合帕博利珠单抗。
尽管从意大利MITO中心选取的受访者样本显示对EC的诊断和治疗创新有良好了解，但除了MSI状态评估外，这些创新在日常临床中并未得到充分实施。
